Final Flashcards
CN I
Olfactory (smell)
CN II
Optic (vision)
CN III
Oculomotor (EOM, raise eyelids, pupil constriction, lens shape)
CN IV
Trochlear (inward and downward movement of the eye)
CN V
Trigeminal (Muscles of mastication, sensation of the face and scalp, cornea, mucous membranes of mouth and nose)
CN VI
Abducens (lateral movement of the eye)
CN VII
Facial (facial muscles, close eyes, speech, taste, saliva and tear excretion)
CN VIII
Acoustic (hearing)
CN IX
Glossopharyngeal (phonation and swallowing, taste, gag reflex)
CN X
Vagus ( talking/swallowing, carotid reflex, pharynx)
CN XI
Spinal (movement of trapezius and sternomastoid muscles)
CN XII
Hypiglossal (movement of the tongue)
Causes of seizres
Cerebrovascular disease Hypoxemia of any cause Fever (childhood) HTN CNS infections Metabolic/toxic condition Drug/alcohol withdrawal Allergies
Characteristics of Grand Mal seizure (tonic clonic)
Last about 2 minutes
Aura occurs
Muscle contraction, periods of apnea (tonic)
Excessive salivation, forceful movement of extremities, rapid pulse (clonic)
Possible incontinence
Stupor 5-10 min following clonic phase
Characteristics of Petit Mal seizure (Absent seizure)
Small movement of face or eyes Staring into space Last for few seconds to a min Occur mostly in children Dulling of consciousness Usually no falling
Characteristics of Jacksonian seizure
Begins with one part of the body (twitching of one side of face of abnormal movement of one hand)
Characteristics of complex seizure
Pt exhibits altered behaviors, unusual sensation (not aware of it)
Nursing care during a seizure
- Provide privacy
- Aura occurs?
- Ease pt to floor
- Push aside furniture
- Loosen constrictive clothing
- Remove pillows/raise side rails
- Note where in the body the seizure began
- Any incontinence?
- Duration of seizure?
- Don’t attempt to pry open jaws
- Do not restrain pt
- Place pt on one side
Nursing care after a seizure
- Keep pt on side to prevent aspiration
- Pt should be reoriented
- Document event leading to and occurring before/after
- Maintain airway
What is status elipticus?
A series of generalized seizures that occur w/o full recovery of consciousness b/w attacks
Medical management of status elilepticus
- Stop the seizure as quickly as possible
- Airway and adequate O2
- IV Valium, Cerebryx given slowly
- Blood samples
- EEG
- Neuro checks
Division of the Peripheral nervous system
Autonomic (involuntary efferent)
Somatic (stimulates voluntary muscles)
Division of autonomic system
Parasympathetic (Rest and digest)
Sympathetic (Fight or flight)
Functions of the frontal lobe
Voluntary movement Personality/Mood initiative/judgement Planning Social behavior Bladder control Concentration Broca's area (motor control of speech)
Functions of the parietal lobe
Attention to stimuli Dressing Drawing Feeling shape and texture Spatial imaging Finding one's way around
Functions of occipital lobe
Interpreting vision
Functions of temporal lobe
Visual memory Facial recognition Music appreciation Hearing Mood (aggression) Non-language
Dizziness
A sensation of imbalance or movement. Can be caused by viral syndromes, hot weather, roller coaster rides, and middle ear infections
Vertigo
The illusion of movement
Normal range of ICP
10-20mm Hg
Patho of increased ICP
Cerebral bl flow decreases, which results in ischemia and cell death. A sympathetic response is activated which causes a subsequent increase in BP. The increased BP then activates the parasympathetic system via carotid artery baroreceptors resulting in a vagal induced bradycardia. (Cushings reflex)
Signs of increased ICP (Cushings triad)
Increase in BP
Bradycardia
Bradypnea
Difference between shock and Cushing’s triad
In shock there is a decrease in BP, and increase in respirations and pulse
Manifestations of worsening ICP
Changes in LOC Restlessness w/o cause Confusion, increasing drowsiness Pt may only react to only loud or painful stimuli Decorticate or decerebrate
Patho of migraines
Often hereditary, associated w/ low Mg levels in brain
Attacks can be triggered by hormonal changes associated with menstrual cycle, bright lights, stress, depression, sleep deprivation, fatigue and odors. Foods containing tyramine (aged cheese), nitrates or milk products may trigger attack.
What occurs in the aura phase of a migraine?
Lasts less than 1 hr, enough time for pt to take medication, Visual disturbances may occur, and may be hemianopic. Numbness and tingling of the lips, face or hands, mild confusion, sllight weakness of an extremity, drowsiness and dizziness may occur.
What are the 5 categories of a neuro assessment?
Consciousness and cognition Cranial nerves Motor system (muscle tone, atrophy) Sensory system (sensation, pain?) Reflexes
3 parts of the Glasgow coma scale
Eye movement
Verbal response
Motor response
A 3 in the glasgow coma scale section of motor response indicates what type of positioning?
Decorticate
A 2 in the glasgow coma scale section of motor response indicates what type of positioning?
Decerebrate
Characteristics of left hemispheric stroke
Slow cautious behavior
Aphasia (expressive, receptive or global)
Altered intellectual ability
Right visual field deficit
Paralysis or weakness on the right side of the body
Characteristics of right hemispheric stroke
Lack of awareness of deficits
Left visual field deficit
Impulsive behavior
Increased distractibility
Paralysis or weakness on the left side of the body
Spatial-perceptual deficit; trouble learning to care for themselves
Criteria for t-PA
- 18years old<
- Clinical dx of ischemic stroke
- Systolic <15sec
- Not received heparin during last 48hrs
- No prior intracranial bleed, AVM, neoplasm or procedure
- No major surgical procedures within days
- No stroke, serious head injury, or intracranial surgery within the last 3 months
- No GI or urinary bleeding within days
Characteristics of Type 1 diabetes
Body does not make insulin Autoimmune response Normal weight Glucose remains in the bl stream Production of ketones
Characteristics of of type 2 diabetes
Insulin resistance (insulin is not as effective)
Impaired insulin secretion
Obesity
More common in adults
S/S of hyperglycemia (hot and dry, blood sugar high)
Extreme thirst Frequent urination Dry skin Hunger Blurred vision Drowsiness Decreased healing
Causes of hyperglycemia
Too much food Too little insulin Illness Stress Gradual onset
S/S of hypoglycemia (cold and clammy, need some candy)
Shaking Tachycardia Sweating Dizziness Anxiety Hunger Impaired vision Weakness/fatigue HA Irritability
Yearly screenings for pts with diabetes
-Cholesterol check annually
-Dental exam 2x a year
-Foot check w/ Dr every visit
-Thorough foot exam annually
-Urine check for kidney damage (microalbumin) annually
Pneumonia vaccine and flu shot annually
-Dilated eye exam with ophthalmologist annually
Foot care for a pt with diabetes
Look for cuts, blisters, red spots, and swelling. Wash feet everyday in warm water Dry well, b/w toes Keep feet smooth and soft Trim toenails weekly Avoid contact with hot surfaces Elevate feet when sitting, avoid crossing legs Never walk barefoot
How is diabetes diagnosed
Hx of the 3 P’s
Fasting bl glucose < twice
GTT
A1C higher than 7%
Educating pt on insulin
Refrigerate Do not freeze or keep in heat Keep at room temp once opened Never inject cloudy into clear Do not use exact same site Insulin should not be injected into limb that will be exercised
Diabetic ketoacidosis is caused by
An absence or inadequate amount of insulin resulting in disorders in the metabolism of carbs, proteins, and fats
Main sx of DKA
hyperglycemia Dehydration and electrolyte loss Acidosis Acetone breath Polyuria Polydipsia Fatigue Blurred vision Weakness HA
Patho of DKA
W/o insulin, the amount of glucose entering the cells is reduced. The release of glucose by the liver is increased causing hyperglycemia. To rid the body of excess glucose the kidneys excrete it with water and electrolytes. Polyuria leads to dehydration. Free fatty acids are converted into ketone bodies by the liver.
What is hyperglycemic hyperosmolar syndrome?
Metabolic disorder of type 2 diabetes resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin
Difference b/w DKA and HHS
In DKA there is no insulin present. In HHS insulin is too low to prevent hyperglycemia but high enough to prevent fat breakdown. Acidosis doesn’t occur in HHS
Sx of HHS
Hypotension Profound dehydration Tachycardia Altered LOC Seizures
Stroke volume
Amount of blood ejected with each heartbeat
Cardiac output
Amount of blood pumped by ventricle in liters per minute
Preload
Degree of stretch of cardiac muscle fibers at the end of diastole
Contractility
Ability of cardiac muscle to shorten in response to electrical impulse
Afterload
Resistance to ejection of blood from ventricle
Ejection fraction
Percent of end diastolic volume ejected with each heart beat
Sx of left sided heart failure
Crackles Dyspnea Dry cough Orthopnea Diminished CO Oliguria
Sx of right sided heart failure
JVD Edema of lower extremities Hepatomegaly Ascites Generalized weakness
Stable angina
Predictable and consistent pain that occurs on exertion and is relieved by rest of NTG
Unstable angina (Preinfaction angina)
Sx increase in frequency and severity, may not be relieved by rest or NTG
Intractable (refractory) angina
Severe incapacitating chest pain
Variant angina
pain at rest with reversible ST segment elevation
Silent ischemia
Objective evidence of ischemia but pt reports no pain
What is Raynuads phenomenon?
A form of intermittent arteriolar vasoconstriction that results in the coldness, pain and pallor of the fingertips or toes. Most common in women
Sx of DVT
Edema and swelling of the extremity b/c of the outflow of venous blood is inhibited. The affected extremity may be warmer, tenderness
What medication should be given to increase contractility in patients with heart failure?
Digoxin
To decrease afterload, what meds should be given?
Vasodialator
Nitroglycerin
Ca+ channel blockers
Beta blockers
ST segment is depressed with
Ischemia
ST segment is elevated with
MI, cardiac injury
What is primary HTN?
High BP from an unidentified cause, most common
What is hypertensive emergency?
BP is extremely elevated and must be lowered immediately to prevent damage to target organs. Goal is to reduce pressure by 20-25% within the first hour
What is hypertensive urgency?
BP is very elevated but there is no evidence of impending or progressive target organ damage.. Associated with severe headaches, nosebleeds, or anxiety. ACE inhibitors and beta blockers are used to treat.
What is metabolic syndrome?
A cluster of conditions that occur together, increasing your risk of heart disease, stroke and diabetes.
EKG changes that occur with an MI
T wave inversion
ST elevation
Abnormal Q-wave
STEMI
Patient has ekg with evidence of acute MI with characteristic changes in two contiguous leads on a 12 lead. In this type of MI, there is significant damage to the myocardium
NSTEMI
The pt has elevated cardiac biomarkers but no definite EKG evidence of acute MI. In this type of MI there may be less damage to the myocardium.
Characteristics of arterial circulatory insufficiency
Diminished/absent pulses Cool/cold skin Loss of hair over toes Dry shiny skin Deep, circular ulcer Minimal leg edema Very painful Intermittent claudication
Characteristics of venous insufficiency
Present but difficult to palpate pulses thru edema Skin thickened Reddish blue skin Minimal pain Irregular border ulcer Moderate to severe leg edema Aching and cramping
What is Buergers disease?
Rare disease characterized by the obstruction of blood vessels in the hands and feet, reducing the availability of blood to the tissues causing pain and eventually damages the tissue
Sx of Beurgers disease
Pain/tenderness Numbness and tingling in limb Skin ulcer or gangrene of the digits Discoloration Pain may increase w/ activity Pulse may be decreased in affected extremity
Sulfonylureas
Glyburide, Glipizide
Tell the pancreas to make more insulin
Metformin
Tells the liver to stop sending out sugar
Glitazones
Avandia and Actos
Help insulin in the body work better
Meglitinides
Prandin, Starlix
Tell the pancreas to make more insulin. Taken with meals
Alpha-glucosidase inhibitors
Precose, Glyset
Slow down the absorption of cabs from the intestines after you eat
Droplet Precautions
Ex: Meningitis, pneumonia, influenza, mumps, rubella
Mask and private room
Doors may remain open
Airborne precautions
Ex: TB, measles, chickenpox
Private negative pressure room
Keep doors closed
Contact precautions
Most frequent mode of transmission
Ex: Hep A, herpes, C.Diff
Gloves, gown, private room in addition to standard precautions
What is Dumping syndrome?
Response to rapid emptying of gastric contents into the small intestine
Sx of dumping syndrome?
Fullness Weakness Faintness Dizziness Palpitations Cramping pain Nausea Sweating Diarrhea
Melena
Tarry or black stools: indicative of occult blood in stools
Psoas sign
Right hand above right knee, raise leg against resistance, flexion of hip causes contraction of psoas muscle. appendicitis?
Chain of infection
Infectious agent Resevoir Portal of exit mode of transmission Portal of entry Susceptible host
Blumberg’s sign
Abdominal wall is compressed slowly and then rapidly released. Indicative of peritonitis
Rovsing’s sign
Pain in RLQ during pressure in LLQ. Sign of appendicitis, or peritoneal irritation
Murphy’s sign
Palpate liver while pt take in deep breath. Sharp pain with no inhalation
Possible cholecystitis
What is gastritis?
Inflammation of the gastric stomach mucosa
S/S of acute gastritis
Abdominal discomfort HA N/V Lassitude Hiccuping
S/S of chronic gastritis
Melena Blood in vomit Anorexia Heartburn after eating Belching Sour taste in mouth N/V Malabsorption on B12
Malabsorption of B12 leads to
Pernicious anemia
What is Peptic ulcer disease
An excavation that forms in the mucosal wall of the stomach, pylorus, duodenum, or the esophagus
Patho of PUD
Erosion is caused by the increased concentration of acid-pepsin or by decreased resistance of the mucosa. A damaged mucosa cannot secrete enough mucus to act as a barrier against HCl
S/S of duodenal PUD
Pain is relieved by food Melena Pain commonly occurs 2-3hrs after meals Awake with pain during the night No weight loss
S/S of gastric PUD
Food does not relieve pain
Pain occurs immediately after eating
Hematemesis
Medication used to treat ulcers from H.pylori
Antibiotic (Flagyl, amoxicillin)
Proton pump inhibitor (-prazole)
Bismuth salts (pepto bismol)
Medication used to treat non h.pylori ulcers
H2 receptor antagonist (Pepcid, Zantac)
PPI (-prazole)
What do Proton pump inhibitors do?
Decrease gastric secretion by slowing the pump on the parietal cells
What do H2 receptor antagonists do?
Decrease the amount of HCl produced by the stomach by blocking action of histamine on histamine receptor of parietal cells in the stomach
What is Crohn’s disease?
A subacute and chronic inflammation of the GI tract wall that extends thru all layers, most commonly occurs in the distal ileum
S/S of Crohns disease
RLQ pain Diarrhea Abdominal tenderness/spasm Cramping occurs after meals Weight loss Malnutrition anorexia N/V Anemia Dehydration
What is ulcerative colitis?
Recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum
S/S of ulcerative colitis
LLQ pain Passage of mucus and pus Diarrhea (10-20 liquid stools) Rectal bleeding Weight loss Anorexia Anemia Fever Vomiting Dehydration
